General Session: Cervical Motion Preservation

Presented by: B. Rischke - View Audio/Video Presentation (Members Only)

Author(s):

B. Rischke(1), J.Y. Lazennec(2)

(1) Spine-Center-Rischke, Zurich, Switzerland
(2) UPMC, Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique – Hopitaux de Paris, Paris, France

Abstract

Background: Lumbar disc degeneration and disc herniation are currently among the most frequently diagnosed spinal diseases. The prevalence of these disorders is anticipated to increase as the population ages in Western countries.

Purpose: To evaluate the efficacy and safety of the visco-elastic LP-ESP-prosthesis in the treatment of lumbar back pain.

Study Design: Multicenter prospective study.

Outcome Measures: The means and standard deviations of the clinical and radiologic variables were calculated at each time point in VAS, ODI and SF 36 scores. Comparisons over time were assessed with paired t tests. Significance was defined as p < 0.05. Survival analysis was calculated by Kaplan Meier method.

Materials and Methods: The analysis included a series of 72 patients ( 44 f, 28 m) with a viscoelastic total disc replacement (LP-ESP). Symptomatic predominant low back pain with or without radicular symptoms associated. Failed conservative medical treatment for at least one year. Idiopathic disc disease after disc hernia without history of infection. Recurrent disc herniation (other than excluded hernias). FU: baseline and postoperative (3, 6, 12, 24 and 60 months) follow-up.

Results: Twenty-eight males and fourty-four females were enrolled in the 5 year FU-clinical study. Mean ODI scores decreased from 47,6% pre-¬‐operatively to 21% at five years follow up. Mean VAS low back pain scores decreased from 6.6 cm preoperatively to 3.4 cm after five years postoperatively. The mean SF 36 mental improved from 42.3% preoperatively to 59.6%, after five years postoperatively, the SF 36 physical improved from 32.4 preoperatively to 57.9 five years postoperatively. The radiographic assessment indicated that the VTDR restored and maintained disc height and lordosis while providing physiologic motion. The radiologic ROM in flexion and extension x-ray -controll indicates in L5/S1 and L4/5 after 5 years FU a normal function in the replaced levels as well as in the adjacent levels.

Summary: In a prospective multicenter 5-years follow-up clinical study the visco-elastic lumbar total disc prosthesis - LP-ESP - performs clinically and radiographically as intended for the treatment of symptomatic lumbar degenerative disc disease maintanining stability as well as mobilitiy of the lumbar spine with pain reduction and improvement of the quality of life.

Keywords: Lumbar disc degeneration; lumbar disc herniation; viscoelastic disc prosthesis